NHHIMA Scholarship ApplicationNHHIMA Scholarship Application Applicant InformationName * Name Name Name Credentials AHIMA Membership ID # Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email * Phone * I am applying for: * HIT/HIA Degree Scholarship Masters Degree Scholarship Coding Program Scholarship Other Healthcare related program Scholarship (specify)Other Healthcare related program Scholarship (specify)Current Educational Institution Name of School * Name of Academic Advisor * Phone * Program Enrolled In * HIT Program HIA Program Other Program (please specify)Other Program (please specify) Date Studies Began * Expected Graduation Date * Resume and Essay Resume * Drop a file here or click to upload Choose FileMaximum file size: 268.44MB Why have you chosen a career in health information management? * What do you see as current or upcoming challenges in the field of HIM? What changes do you see happening in the field in order to meet these challenges? * What are your long-term professional goals? * References and Proof of NH Residency or Employment in NHPlease submit two reference letters. References may be from educators, employers, or other health information professionals (no more than one letter may be from an instructor). Reference Letter #1: * Drop a file here or click to upload Choose FileMaximum file size: 268.44MB Reference Letter #2: * Drop a file here or click to upload Choose FileMaximum file size: 268.44MB Proof of NH Residency or Employment in NH * Drop a file here or click to upload Choose FileMaximum file size: 268.44MBTranscriptPlease provide a current transcript documenting completion of most recent semester (official transcripts are not required, but are encouraged). Transcript * Drop a file here or click to upload Choose FileMaximum file size: 268.44MBMy name will be posted to the NHHIMA website if I am awarded a scholarship. * Agree Disagree If you are human, leave this field blank. SubmitΔ
